Glad to hear your ACDF was successful. I have certainly seen cases in which a "lump in the throat" sensation persisted for a few weeks or even longer, but in the vast majority of cases, this sensation should resolve over time. Very few patients have persistent swallowing discomfort 3 months post surgery. Your surgeon will most likely order a radiograph of the cervical spine on your next follow up visit to reasure that the plate and screws have not migrated. This would be very unlikely, and in all likelihood your lump will resolve on its own.
The coflex-F device is primarily used for cases of symptomatic lumbar stenosis that generally improves with positional changes such as with flexion and sitting and is primarily due to soft tissue such as a disc buldge. As in other inter-spinaous distraction devices it should be understood tha the predictability of success with this operation is more in treating leg pain (from stenosis) than for back pain. Either way, do not expect a 95-100% success rate with any surgery, certainly not a spine operation for back pain. You may have mis-understood the surgeon. If not, please consult with another spine surgeon to avoid false expectations. In my practice I have had good success with relief of leg pain (about 85%) with the selective use of inter- spinous devices similar to the coflex. Do not feel rushed to make a decision, and remember that there is only limited long term data on this procedure which is otherwise safe and relatively minimally invasive. Certainly, another opinion by a spine surgeon performing these kind of procedures would be very reasonable for you to consider.View Thread
If the lumps are not painful and you are otherwise doing well from your surgery, this problem is probably not dangerous in the short term. Nevertheless, it is possible, though unlikely, that the lumps represent some loosening of your hardware which may or may not be clinically significant. No one would be in a better position than your own surgeon to examine these lumps and reasure you as to what they represent. You should make it a priority to see him, and don't let $200 get in the way of your recovery. Besides, being that you are a post operative patient of his, I am confident that your surgeon will be flexible with you regarding the $200 debt. I wish you all the best medically and financially.View Thread
As a spine surgeon, I am convinced that your post operative leg cramps are frustrating not only you, but your surgeon as well. Typically when one of my patients experiences leg pain, numbness, tingling, or cramps after a fusion operation, I first rule out nerve compression or instability. These issues can sometime respond to well to surgery when indicated. Based on the information you have provided, I am confident that your surgeon did not find evidence of nerve compression or instability to explain your leg cramps. That is why you were referred to the Neurologist who has been trying to identify non-spine-surgical sources of your crampings. Regardless of the cause of your cramps (which hopefully will be identified or better yet resolve on their own) you should consider certain medication options that can be very helpful particularly if taken at night-time which is when you experience most of your cramping. Please consult your neurologist regarding options for meds to address your symptoms. I wish you a quick recovery.View Thread
By now you have had two discectomies over the course of the past 3-4 years and it seems that unfortunately are still having significant chronic L5 radiculopathy. Though I am not certain as to what is your current pathology, it is possible that you have a degree of intrinsik nerve injury that may not predictably improve with a third surgery to address scar tissue. In this scenario, if there is no significant compression from a reherniation or evidence of instability, and if your leg pain is dominant (over low back pain) you may want to consider a spinal cord stimulator trial. You should discuss this option with your pain management physician and/or surgeon.
I wish you all the best and hope you soon find pain relief.View Thread
From a spine surgeon's perpective, it appears to me based on your information, that there is a weak correlation between your symptoms and the objective finding on the MRI and possibly physical examination. That does not mean that your symptoms are not real or not severely affecting your quality of life for the past 18 months. All it means is that in this setting the predictability of surgical intervention is rather limited. I am confident that leaving all worker's comp issues aside, your orthopaedic spine surgeon would be thrilled to offer you a surgical procedure if he was convinced it would reduce your pain, improve your funciton, and better your quality of life. Just because he did not offer you surgery and gives you medication instead doesn't mean he has anything but your best interest in mind. It is simply that he feels he does not have the ability to help you with surgery. I am faced almost every day with patients who have significant pain and disability that does not correlate with findings such as instability or nerve compression that I can fix with surgery.
Nevertheless, I am not suggesting you give up. Not at all. If not done already, I would certainly consider additional imaging modalities such as a cervical CT scan (preferably with oblique reconstructions), flexion extension films, and possibly a nuclear bone scan. Also if you have not had any diagnostic injections such as facet blocks or even a slective epidural steroid injection, your surgeon may want to discuss these options with you. Finally, a second openion by another surgeon may be particularly refreshing and most likely will be woth your time, at least for reasurance puroposes.
Most importantly, keep a positive attitude and take control of your life. Let your lawyer deal with the legal aspects and keep your focus on getting back to a normal productive life.
Clearly one cannot make a meaningfull diagnosis based on the information you have provided. Despite your having significant symptoms that appear to affect your quality of life, it sounds like at the very least you should be reasured that you do not have dangerous condition. That being said, I am not sure what diagnostic workup you have had so far. For example, it may be reasonable to get a cervical spine MRI in your case and I am not sure if you had one already. If you have not seen a spine specialist (either orthopaedic spine or neurosurgeon) this far, I would recommend you do so. I am not suggesting this because I necessarily think that there is a surgical solution to your symptms, but because they may be better at identifying a potetial treatable source of your pain to direct treatment accordingly. Keep us updated.View Thread
There is light at the end of the tunnel. Don't be discouraged, there is always hope.
Based on the information you provided, you now have chronic disabling low back pain and also radiating pain to your legs. Your MRI demonstrated at least one level with annular tears, but possibly others. You have failed to improve despite reasonable conservative measures including injections.
First, in response to one of your concerns, it is very unlikely if not impossible that a facet injection caused you to have a disc rupture.
Second, in your situation, discography could potentially be a useful diagnostic tool to confirm that indeed your pain is the result of your annular tears either at one or even two levels. If discography proves that to be the case, you may be a reasonable candidate to consider surgical intervention (in the form of a fusion most likely) as a last resort based on quality of life considerations. Although there are no guarantees, success rates with one or two level fusions after a positive discogram can be as high as 80-85%. If, on the other hand, the discogram fails to demonstrate a focal disc or two as your pain generators, you would probably not be considered to be a good surgical candidate.
Consider proceeding with discography, and most importantly, stay positive.View Thread
It sounds like you have been experiencing significant symptoms of nerve compression prior to surgery. You did not specify whether your most recent discectomy was at the same level and side as your original discectomy. If that was the case, it is generally expected that your recovery would be more prolonged compared to a discectomy performed at a level and side that had not been previously operated. Regardless, at 6 weeks post surgery it is not unusual to still have residual numbness. Numbness can sometimes persist for several months after a discectomy and in some can cases, some degree of numbness may be permanent. Your description of saddle numbness is not particularly specific especially in the context of otherwise improvement in lower extremity pain, strength, and numbness. If you experience, however, bowel or bladder dysfunction (such as incontinence or retention) or weakness in your legs that is worsening, you should report this to your surgeon ASAP. Otherwise, continue with PT and you will continue to make progress.
As a surgeon, I can confess that the art of finding the optimal dose and regimen of pain medications for my patients, particularly narcotics, is far from perfect. As clinicians we struggle with our desire to provide the patient with adequate pain relief while minimizing the long term risks of narcotics including dependency as you mentioned. It is possible that you are currently under medicated and if your current pain management doc does not feel it is appropriate for you increase your dose, you should consider seeking a second opinion. At the end of the day this is a risk/benefit ratio decision like many others you and your spine surgeon and pain doc have to do as part of your treatment including your decision to possibly have another fusion.